Very high power short duration as re-ablation strategy for recurrent atrial fibrillation

After initially successful pulmonary vein isolation (PVI), some patients experience recurrence of AF requiring repeat catheter ablation. Radiofrequency ablation (RFA) is then mostly performed with low power long duration settings (LPLD), while very high power short duration (vHPSD) may be a valuable alternative. This study aimed to compare procedural parameters, outcomes and complication rates of both approaches. All consecutive repeat procedures for recurrent AF between 12/2019 and 03/2023 were retrospectively analyzed at our center. Only patients with at least one prior ablation were included. RFA was performed using LPLD (≤ 40 W) or vHPSD (≥ 70 W, 7 s). Ablation strategies were at the operators’ discretion. A total of 340 procedures were included (LPLD: 292; vHPSD: 48). Re-PVI was necessary in the majority of cases (LPLD: 67.8%; vHPSD: 70.8%; p = 0.7). Additional ablation lines were performed in 59.9% (LPLD) and 75.0% (vHPSD; p = 0.1). In the vHPSD group more patients underwent substrate modification (CFAE ablation/scar encirclement; LPLD: 27.7%; vHPSD: 45.8%; p = 0.017). Despite this, RF delivery time was shorter with vHPSD (LPLD: 2024 ± 1014 s; vHPSD: 1591 ± 936 s; p = 0.006), while total procedure duration (LPLD: 142.8 ± 45.8 min; vHPSD: 139.2 ± 48.2 min; p = 0.7) and complication rates (LPLD: 5.1%; vHPSD: 8.3%; p = 0.3) were similar. After a median follow-up of 361 days, arrhythmia-free survival was comparable between groups (LPLD: 65.7%; vHPSD: 68.8%; p = 0.8). vHPSD is an efficient alternative to conventional RFA in repeat procedures for recurrent AF, even in complex cases requiring extended lesion sets.